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It’s been over a year since we first learned about COVID-19, and although we are still far from the end of the pandemic, there is reason for hope. Infectious disease expert, Frank Esper, MD, takes a look at where we are now and what needs to happen next. He chats about herd immunity as a moving target, current vaccination rates, vaccine hesitancy and the latest findings about variants and mutations.

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COVID-19: Where We Stand Now and What the Future May Hold with Dr. Frank Esper

Podcast Transcript

Cassandra Holloway:

Thanks for joining us for this episode of the Health Essentials Podcast. My name is Cassandra Holloway, and I'll be your host. Today, we're talking with pediatric infectious disease expert Dr. Frank Esper about where we stand currently regarding the state of COVID-19, and also where we stand with our vaccination efforts.

Dr. Esper, thanks for being here today and welcome to the podcast.

Dr. Frank Esper:

Hey, Cassandra. It's very good to be here again.

Cassandra Holloway:

So, it's been over a year now since we've first learned about COVID-19, and it's hard to say who could predict how exactly the virus would have impacted our lives, and basically the whole world as we knew it. So, Dr. Esper, we have so much to unpack in this episode. I remember having you on this podcast early on in the pandemic when we first started talking about this novel coronavirus. So, the first thing I want to ask you today is just how you're feeling about the current state of COVID, and what are your thoughts and how far we've come this past year.

Dr. Frank Esper:

Yeah. Listen, we have had a roller coaster ride over the last 12 months. Honestly, when we spoke last March, last April, I forget exactly when it was, but it was, at the beginning, we were looking into the unknown. We was just at the beginning, we didn't know what to expect.

              Now, we're at a spot where we could actually envision the end of the pandemic phase of this particular virus, but we're not there yet. Just like over the last 12 months, there have been a lot of unexpected turns and twists in the road. I'm sure there are still some to come, and that's one of the reasons why we're looking at the virus so closely and what's happening with different variants in different parts of the world worrying that this virus may throw us another curveball again.

              So, we're still looking very closely and we still don't know exactly what the future holds, but we certainly know that we have come very far and know a heck of a lot more now than where we were when it all began. If you think about it, the first few months from the time when we first saw those images in China, in Wuhan, where they were welding doors shut and holding people back and spraying bleach into the air down the roads. I mean, it was amazing that we didn't know anything about this particular virus, and what we did see was just a huge push of information.

              One of the best things that came out of this was how the world came together, at least the scientific communities within the world came together to give so much information so quickly, almost too quickly. It was hard for us to digest it all, but there was just so much information coming out, and we were opened up. Whatever information we had, we gave it, we were sharing it, and it really helped everybody to understand what was going on and how to make medications, which we were able to do in order to help treat this virus, to come together with products like convalescent serum and monoclonal antibodies to help people survive or prevent them from getting infected or, I'm sorry, prevent them from getting hospitalized when they get infected with this virus or to actually getting to a point where we have vaccines in under a year's time, which was just unheard of before.

              Not to say that we took any shortcuts, but what we did cut was a lot of the red tape that was usually stymieing being able to produce things quickly, but we never stymied on the safety and effectiveness research. So, it allowed us to really streamline the ability to make something when the world comes together to have something in under a year that will actually prevent this infection.

              So, we have certainly come a long way. There's certainly been some good points and bad points, things that we just did wrong, and things that we learned from those mistakes, but all in all, we have definitely come a long way. We are in a lot better than where we were last year. I would say, as I said, we could see the light at the end of the tunnel, but we are not out of the tunnel yet.

Cassandra Holloway:

Yeah. Like you said, it's amazing to look back on the progress we've made this past year, and like you alluded to, the world's most brilliant minds and doctors, and medical experts were all working on this and exchanging their knowledge and information, and it was cool to see the world come together in that term of learning and knowledge.

Dr. Frank Esper:

Yeah. We actually have a dedicated area now just for coronavirus-related research so that we could find it. The number of papers and investigations and reports that are coming out was an exponential rise. There were basically tens of thousands a week of new research from all over the world.

              Again, there were some good things about that and there's some bad things about that, but the answer was is that we were all, the scientific community was all in on trying to get the information out to help understand and help treat and help get over this pandemic.

Cassandra Holloway:

You mentioned the vaccines, and I want to talk a little bit about just this general concept of having these vaccines available to us now. Where are we currently regarding vaccination rates in the US?

Dr. Frank Esper:

The vaccination rates in the US has been astounding, if you think about it. We've only started this in December. So, we're coming on month five or so of our vaccination campaign, and we're trying to vaccinate everybody. Everybody who wants the vaccine should get the vaccine within the safety recommendations. It's amazing because this is also something that's unparalleled. Trying to vaccinate hundreds of millions of people in a short period of time is a daunting task that we have been doing very well at. We're almost at the point where almost 50% of people have received at least one dose of the vaccine, and over a third of people have been vaccinated completely by receiving the two dose of the vaccines that require two doses.

              So, that's just an amazing number of people when you talk about it. We have 350 million people in this country, and we have been able to administer hundreds of millions of doses of this vaccine safely, effectively, and we have seen substantial improvement because of it.

              Most importantly, when we talk about who it is that are really at most risk of getting really sick and hospitalized, people over the age of 65 are nearly 85% vaccinated at least with one dose. That's a fantastic number, and it tells how many people are really bought in to the vaccine, to receiving the vaccine, to protecting themselves, to protecting those around them by making sure that they themselves do not become infected and then spread it to your family or your community. That's what this vaccine is all about. The vaccine is not just about protecting yourself, but it's also being a part of this effort in our country to stop this virus and to get our lives back to a little more normal.

Cassandra Holloway:

There's been a lot of media coverage lately about experts now talking about this concept that herd immunity might be out of reach for the US due to vaccine refusal and vaccine hesitancy. You talked about people who have bought into this vaccine and getting their vaccines and getting vaccinated, ultimately. What does it mean when these experts are hinting that herd immunity might not be within reach at this point? I feel like that's all you've heard over the past year is get to herd immunity. That's been our goal. What should we be thinking about now in terms of this new information coming out?

Dr. Frank Esper:

Listen. We always knew that. We said it was going to be a daunting task. The herd immunity is a bar that we set to prevent persistent and continued spread within our community, and that is a very high bar. We still don't know exactly where that level is. It was estimated somewhere between 50% to 80%. As new variants become more and more transmissible, it gets closer to the 80% and moves away from the 50%.

              As I said, we're already approaching that 50% mark nearly with at least one dose. When you talk about the individuals over the age of 65, we have made that 80%. So, to say that we won't make it, well, I don't know what the future holds, but that's not to say that we can't make it.

              We have 80% vaccination rates with a lot of our vaccination efforts when you talk about things like the childhood tetanus series and the childhood polio and the childhood measles, mumps, rubella. Those are all closer to 90%. So, when we dedicate ourselves to this effort, then, yeah, we can make it. We can make it.

              Now, we don't know how this virus is going to change. Remember, it's trying to outrace us, and become more transmissible so that our vaccines aren't able to stymie its ability to spread. It is basically just, it's us versus them when it comes to our vaccine versus the virus' ability to escape or to mutate so that it allows it to escape immunity. This is going to be a back and forth that we're going to be dealing with. It's going to be something that we're going to be dealing with for several years.

              I don't necessarily know, though, that we should be saying, "Oh, we're going to get this herd immunity," and then this virus is going to wave the white flag and say, "Oh, I'm just going to go off into extinction." No. What we're trying to do is get this to the point where we're no longer in the pandemic phase, where we're no longer dealing with persistent, constant waves and waves and waves of infection.

              I would expect that this virus is going to become, if we do our part and we work with our community and getting everybody who can be vaccinated, that we get to the point where we're only going to see seasonal episodes of this virus like we see seasonal episodes of all these other viruses that show up usually in the late fall, early winter with the influenza waves this and the croup waves and the rhinovirus waves, and all that. We would see this coronavirus join that type of routine, where we basically say, "Okay. We're now in the coronavirus season," and we get ourselves ready to prevent the infection like we do all the infections during the winter.

Cassandra Holloway:

That's interesting you said as we move through different parts of the pandemic or different stages of it. It sounds like herd immunity is likely to be this moving target as we move through this stages, but we should still push for mass vaccination and protecting our most vulnerable populations as well.

Dr. Frank Esper:

Yeah, and let's be honest. While we have not reached herd immunity and we certainly know that, we have seen evidence that the vaccinations are helping. Herd immunity is all based on your community, but if your community is very small, let's say you're talking about a community within a long-term care healthcare facility, if everybody in there is immunized, then that local environment has reached herd immunity within that building.

              When we look at those individuals over 65 years of age, a fantastic number have said, "Yes, we are going to protect ourselves and we're going to protect our loved ones, and we're getting our vaccine." We have seen substantial drops in the number of people in that age group who are being hospitalized and who are being infected.

              The age, because of such, the more people that we're seeing right now that are being infected or at least the new cases are actually younger individuals because they haven't had the opportunity to get vaccinated, and we're still just ramping up the younger age groups right now.

              So, it's something to say that even though you don't reach herd immunity, you still see a substantial improvement in the number of cases, and the number of hospitalizations, and the number of deaths that come from this virus.

Cassandra Holloway:

So, since the vaccines came out in December for the US, there's been constant rumors and misinformation, especially shared on the internet. One of the most common myths that we keep hearing about is this idea that the vaccines can change or alter your DNA. So, I just want to set the record straight. Can you break down for us DNA versus RNA, and why are people so worried about the vaccines potentially changing your DNA?

Dr. Frank Esper:

Yeah. All right. So, I mean, the whole issue of vaccine hesitancy is a big one. Let's be honest. It's that vaccine hesitancy is not something new in this country. Vaccine hesitancy is not vaccine refusal. The people who are actually adamantly against the vaccine is a very, very small number of people, but they're very vocal. They punch above their weight. They are extremely savvy when it comes to social media and how to get their message out, so that one person sounds like 100.

              The answer is that the people who are actually against this vaccine, truly against this vaccine are actually a very, very small group of individuals that are just trying to muddy the waters for everybody else and make them hesitant, and the people who are hesitant are just like, "Oh, hold on. I'm hearing a whole bunch of chatter. I don't know what to do, and so I'm just going to stop and wait." That's, honestly, what a lot of the people who are actually anti-vaccine, they understand that they may not prevent you from getting the vaccine, but they can prevent you from getting it quickly. They can't prevent you from doing it when you're able to do it, and they slow you down. That's what a lot of these individuals are just trying to do. They want to slow you down from you getting your protection.

              Remember, also, it's there are people against this vaccine before there was a vaccine. People were against the coronavirus vaccine last February and last March when we were just saying, "Guys, we're going to just try to make a vaccine," and they're like, "We're against it," before there was any reason or any data to say what worked, what didn't work.

              It is also very important to remember that while people are saying, "Oh, my God! We only started the vaccine in December," no. The vaccines, the earliest trials of the vaccines were previous summer. So, we have data on thousands, tens of thousands of people since last coming up about a year now from June and July of 2020 who have gone a whole year without issues at all. In fact, the number of severe adverse events is very, very small. That's not to say that it's zero, and I won't event try to convince you that you can't get a side effect. A vaccine is a medicine. Every medicine has side effects. When you give a medicine to everybody, 100, 200, 300 million people in this country, you're going to have side effects.

              If I gave penicillin to 300 million people over a five-month period, I'm going to have a whole bunch of hospitalizations and severe side effects. That's not to say the penicillin is a bad medicine. It's just to say that when you give it to everyone, there's always a chance that in a very, very small 0.000001%, but you multiply that by 300 million people, you'll find a handful, but we definitely found is a lot of people who did not get sick from this coronavirus because they were vaccinated, people who did not die because they were vaccinated, they didn't get hospitalized, they didn't spread it to their family or to their community.

              What a lot of people who are truly anti-vaccine who are trying to spread this cloud of concern, it basically is not really working. The vast majority of people, when you look at our numbers, nearly half of America has already gotten at least one dose of the vaccine, 80% plus of people over the age of 65. For months, people have been doing great. So, I think, for the people who are truly vaccine-hesitant, who are not against it, but they're just a little unsure, time is going to show you that this vaccine is doing right. We did not skimp when it came to safety evaluation. We're still looking at safety evaluation.

              The fact that we actually paused one vaccine for a handful of cases shows you that we're on guard looking for any possibility of a problem, and if so, we will stop it like we were supposed to until we understand the problem better. So, it shows you that we are doing what is needed to get through this pandemic, to open up our country, to get back our lives, and do it in a safe way.

Cassandra Holloway:

Absolutely. Yes. Great message just how these safety guidelines are in place to protect us. Like you said, if pause needs to happen and more research and data needs to be analyzed, then we absolutely will do that as we continue to move throughout these stages of the pandemic at this point.

              I did want to set the record straight for our listeners here today. So, people who are worried about the vaccine changing their DNA is also by any stance correct.

Dr. Frank Esper:

Right. So, going from what is DNA, what is RNA, and what's the difference between the two. The DNA is actually our genetic code, the building block for us that we use to pass to make more cells. Basically, what happens is that DNA is the blueprint. It then makes RNA. RNA takes that message to then make protein, which is basically what makes us. Those are actually what we are made of. We are made of proteins. That proteins come from a message, that message was the RNA, that was transcribed from the blueprint, which is the DNA.

              For the most part, in human cells, it only goes one direction. It only goes DNA, make RNA, makes protein. You can't take a protein and then go and then basically somehow makes an RNA, and then the RNA makes a DNA. That doesn't work in human cells that way. So, when we are using an RNA vaccine, all right? So, that's right in the middle. RNA can only go one direction and that is make a protein. So, RNA cannot go back and make DNA. So, what we're doing with an RNA vaccine, which two of our major vaccines are, is basically it's an RNA that just has a specific piece of the virus called the spike protein, and that basically gets made into a protein. The human immune system says, "Hold on. I don't like this protein. This protein is not a part of me, and I'm making immune response against that protein so that I will be able to reject that protein should I ever see it again."

              Therefore, if that virus ever shows up, showing its old spike like a protein, the vaccinated individual is able to kick it out saying, "Hold on. I know what you look like. You're out of here." That's how this vaccine works. It does not alter your DNA. It does not alter your code, your genetic code or anything like that.

Cassandra Holloway:

So, I want to talk briefly about restrictions here. So, obviously, restrictions and lockdowns vary by state and even by country. Pretty widely here is we're seeing cases go up. In certain areas, restrictions are being lifted. It's this confusing message about what should we be thinking of, what should we be doing. Are experts concerned that we're reopening too soon and what should we be considering as restrictions ease?

Dr. Frank Esper:

Yeah. The issue of restrictions is ... Our country and our life is not run by scientists. We cannot dictate how we live based on math and the scientific formulas and things like that. I mean, we as scientists make our recommendations of this is the best way to handle this pandemic, but then it is the politicians and the community leaders who have to take that information and say what is best for our community. Just because we know what's best to fight this virus doesn't necessarily mean what is best. There are other circumstances, and a lot of people are most focused on the economic problems that this virus has caused, and what it is that they can do in order to maintain a livelihood.

              So, a politician who are making those guidelines, and a lot of the politicians are working with the scientists very closely to say, "What is it that we need to do?" We have to make recommendations on what is able to open up, when is it safe to open up, who can come out first, who's second, where are we from a vaccine status, what's our coverage rate in our community, what's the type of virus in our community, what's the different variants that we're seeing circulating, et cetera.

              It's not as simple as, "There's still virus. Keep everything shut down." There is no magic number at which point in time we're going to say, "Hey, it's okay to come out." In life, nothing ever is 100%. We don't know what the future is going to hold. So, sometimes, and this certainly happened in the beginning of the pandemic, recommendations that we had in one week were changed and made different the next week because we had more information and things changed on the ground that we had to adjust to.

              When it comes back to opening, I think that what you're going to find is the more we open up, the more that we start getting out and moving and traveling from place to place, we're going to see more of the virus, and we're going to see different types of this virus. So, you're going to see probably as we open up, we're going to see an uptick in the number of cases in the community.

              However, that is at least better this time around because what we have a fantastic number of people over the age of 65, people who are really at risk are protected, and more and more people are also even outside those age groups are becoming protected, and we have protected infrastructure within our community so that we're not going to see the hospitals completely overwhelmed because all the nurses get sick at once or a police department where all the policemen get sick at once or a fire department or grocery and delivery of essential supplies, and the trucking, et cetera.

              That was what we were worried about from the beginning is that you can completely get everybody sick within a very vital area of the community and then what are you going to do. When all the firemen are sick and they can't come out because they're contagious, who's going to fight the fires or who's going to drive the ambulances? Who's going to stock the food sources that we need? This is what we were trying to avoid.

              When you say, "Hey, this lockdown was just so terrible. Was it really needed?" the answer is the fact that we got through it shows that it worked because we could certainly see a point where what happens when your hospital is overwhelmed. What happens when you don't have enough beds, you don't have enough ventilators, you don't have enough nurses or doctors? We've seen that around the world, and we, thankfully, did not get, we came close, but we did not reach it here because of everything that you and I did in listening to our state, federal, local, health providers, and following their guidance.

Cassandra Holloway:

Yeah. So, along those lines, there's obviously this very serious health crisis happening in India right now regarding COVID-19. How did it get so bad there, and what can we learn from what is happening there here in the US?

Dr. Frank Esper:

Yeah. Listen. What's going on right now in India is terrible, but we were there. We know exactly what they're going through. We saw it here in the United States over those last third wave, and they're basically going through what we just went through, but you have to understand also, they have three times, four times as many people as we do. Their ability to socially distance is not nearly as the ability for us to socially distance. They are much more crowded. Their living spaces are much smaller. They don't have the infrastructure that we have here in much of their countries.

              They have some topnotch hospitals, but the number of hospitals to the number of population that they have is very, very different than what we have here in the United States. So, what they're seeing is a huge wave and a huge number of cases that is really pushing their ability to respond.

              Part of it is just basically their circumstances. India is not the same as the United States. So, their circumstances are different, but, also, the virus continues to change. This virus that is happening right now is becoming more transmissible. That is the way it wants to evolve is to become more transmissible so that it can spread to more and more people.

              The virus right now is just much more transmissible than it was just five, six months ago. Unfortunately, that's where they're at right now, and the best thing that we can do is try to support them through the World Health Organization, and as well through our government giving whatever support we need.

              Understand that while what we went through, we're thinking of ourselves, we're in this all together from a country standpoint. We're really in this all together as a world. It really is going to be important that this is something that we have to ... It's daunting to think of what we have to do in order to protect everybody in the United States, but we really need to protect everybody in the world when it comes to really getting a hold of this virus and preventing it from continuing to evolve and cause problems. So, it's a huge task that's happening right now here in the United States, but also in India, still in China, still in Australia, South America, Greenland, everywhere.

Cassandra Holloway:

I know we talked earlier about this just mass amount of this amazing research that has been done over the past year. I know you led a genetic study about COVID mutations, which had some really significant findings. Can you explain to our listeners a little bit about that study and what your team learned from that?

Dr. Frank Esper:

Yeah. This is a study where we were actually looking at the variants before variant was a thing. We were looking at how these mutations change and how these mutations affected the outcomes of people who got sick. So, with variant one versus variant two, versus variant three, we were trying to see who got hospitalized, who got sicker, who died more so, and what mutations were associated with that.

              We did this early on in the first wave of the pandemic. I would say that two of the biggest takeaways from this study was, one, that in the beginning of the pandemic, right in the beginning, we had a huge amount of diversity. So many different types of viruses were all circulating here at the same time. That was probably true everywhere.

              What was happening is because we did not shut down, this was right the beginning, before everything really locked down, we were probably getting reintroduced, new strains were just popping in and starting little mini epidemics, and that's why there was just this huge diversity that then once we shut down, that diversity went away.

              How that relates to right now as we start to open up as we mentioned before, we should start to think that we may start getting peppered with different types of viruses, different variants of virus within our community. So, we're going to find different strains circulating at the same time.

              The other was that how a dominant variant, a dominant mutation can overwhelm all the others and how quickly. In a matter of days, two weeks it would go from six different strains to being within the community to a predominant form showing up and just outgrowing everything.

              Now, part of that is because we shut down, but it shows that one type of variant, if it has an advantage over others, it will quickly outgrow. That again goes to what are we dealing with right now. Well, why are we talking about variants? Why are we watching variants? This is one of the reasons why.

              Now, we did find that there were also significant consequences of variants that lead to more people dying or more people being hospitalized. What we found was that the first strains right out of the gate were the most severe. The ones that just first showed up were actually the ones that caused at least pound for pound the most disease, severity of disease, but then as this virus mutated and one form became really dominant, the dominant form was a little less severe.

              So, what this virus is doing is it's basically weighing the severity of illness versus the transmissibility of the illness and saying, "Hey, I'd rather be more transmissible than really severe."

              A virus, when you think about it, a virus just has, and I tell this to all of my students and my residents, a virus has a simple modus operandi, all right? All it wants to do is it says, "I want to infect you. I want to make a million babies, and then I want those babies to get out to infect other people." All right? Nowhere in that sequence does it say, "I have to kill you." All right? "I just want to infect you. I want to make a million babies, and I want to get out." All right?

              "If that means you get really, really sick, maybe my babies don't get out very quickly or they don't have as much of a chance to get out because you're bed bound or you're hospitalized or people recognize you're sick and you recognize you're sick so you don't get around."

              So, some of the most effective viruses are ones that don't lead to really, really severe disease. I think this coronavirus is figuring that out. It's saying, "Hey, yeah, at the beginning, I was really, really bad, but as I become more and more transmissible, it's because I'm not causing people to be as sick as much."

              Let me tell you right now. This is still a really, really severe virus. Even though it has mutated to the point where it has become more transmissible and it is less severe, that less severe is not zero, and it is still causing severe, severe disease. By being able to transmit itself to more and more people, even if it's a fraction of its severity, it is being amplified by being able to infect more people.

              So, we still see these waves of people being hospitalized, but we thankfully are not seeing the death rates that we were before, and this is one of the reasons why. That's what our study is showing.

Cassandra Holloway:

So, should we always expect COVID-19 to continue to mutate as we move through the pandemic? If that is the case, how do these new variants or these mutations play into or how do you anticipate that they will play into our yearly COVID shots or booster shots?

Dr. Frank Esper:

Yeah. I think that we should expect that and that this virus is not going to, as I say, just ride off into the sunset never to be seen again. No. This virus is going to be here, but it's not going to be in the same pandemic form like where we're at right now, where we're dealing with waves in the spring and waves in the summer. This virus will probably prefer ... There's actually a whole bunch of other human coronaviruses out there. They all like to circulate in November, December, and January. I would expect that this coronavirus will eventually find out that, "Hey, that's my sweet spot, and that's where I want to cause problems."

              So, eventually, we'll get to a point where there will be a coronavirus season just like there is a flu season, and probably, actually, overlap one another. That will make things a lot easier, at least now that we have prep time that we know, "Okay. This is when to expect it," but we are still at a point where there are just so many people who are still very susceptible to this virus because we haven't gotten everybody vaccinated yet. Because there's still so many people who are susceptible, this virus can persist.

              We get enough people vaccinated, this virus will not be able to persist perpetually until it gets to that perfect sweet spot season, and then it will start turning and causing some infections there.

              Now, when it goes to the mutations, what I would say is what you're going to see is that we're going to be playing a little bit of a tennis match with the virus. We're going to have a vaccine. That's going to prevent this virus from circulating as well as it wants to the virus. Now, the ball is in the virus. The virus is going to say, "Okay. I'm going to change a little bit," throw back to us, we're going to have to change the vaccine, back it back down to them, and so we'll go back and forth for a little bit.

              Every time that we get more and more people who are going to be vaccinated, we're going to say a substantial decrease in severity of infection, severity of illness, hospitalizations. I think we will get to the point where similar to where we were with the flu shot, we're going to have an effective vaccine that is not going to eliminate, but is going to prevent a lot of people from getting very, very sick.

              I don't believe we're going to require a yearly vaccine for this virus because this virus does not mutate nearly as much as the influenza virus does, but in the beginning, I think we will be talking about several boosters over the next few years, and then eventually we're going to get to a point where it's probably going to be something that we'll vaccinate every other year or something like that.

Cassandra Holloway:

As an infectious disease expert, what advice do you have for people about continuing to wear face masks and keeping a distance and continuing to be adamant about washing their hands? Why is this still important right now and why will it continue to be important into the foreseeable future or as we move toward this seasonal theme that you keep talking about?

Dr. Frank Esper:

Yeah. Well, it's because we're not done yet. There's no reason for us to stop what we do know works. Does mask and social distance and hand washing, does it stop this virus cold in its tracks? No. The virus is still able to spread as we have already seen, even though everybody was wearing masks and washing hands, at least a lot of people were. So, it's not 100%, but it helps slow the spread.

              While this virus is still out there and during the times that this virus is circulating in the community, which it is still circulating in our community, we should continue to do everything we can to prevent this virus from infecting us and infecting other people around us. So, wearing the masks, and socially distancing, and hand washing are still going to be some of the things that are very, very important.

              It's also going to be important, as I said, that if we start opening up, as we get our kids back to school, as people start saying, "Hey, maybe I can get out of the house, go to a restaurant, take a small trip," something like that, you're going to see that new variants are going to start peppering our area.

              So, if we are still masking and washing our hands and socially distant, those new variants will not be able to get as much of a foothold, especially as we're still learning about them, if one of them happens to be a little worse or much worse than others, we'll be able to hold that back while we understand what's going on and identify the people who are infected and preventing that from just exploding in our community like what happened over the last year.

              So, it is still very important that we will continue to do some of the strategies that we've been doing for the last year, and being augmented by the fact that we are also becoming more vaccinated and becoming more immune is going to be something that is really going to push this virus, hopefully, down, down, down.

              I will expect that we are not going to see a change in the mask and the social distancing mandates probably through this year, certainly not until the end of next winter. As much as we're going to try to open up, and I think that we will see things open up more and more as we get into the summer, I don't think that the federal guidelines are going to say, "Hey, we're going to stop wearing masks," or that we will stop recommending wearing masks and stop recommending social distancing. We're still in the fight, and we don't want to take our foot off the gas pedal just yet.

Cassandra Holloway:

So, Pfizer is working fast and furious on potential drugs to treat COVID and also vaccines for different age groups. So, I want to talk to you a little bit about two Pfizer initiatives. The first one is the COVID vaccine for kids ages 12 to 15 that the FDA will likely review in the short future here. Can you talk a little bit about that vaccine for children, and then what should parents know specifically about it?

Dr. Frank Esper:

Yeah. People were asking a lot about children from the beginning of the vaccine campaign. Many people understand and are very comfortable with vaccinating their kids. It's vaccinating the adults that it's a little more unusual, but the answer is that children, if there was a silver lining of this virus, is that children were not as affected. That's not to say that they can't become infected and they can get severe infections. We have seen severe infections, but they're not as affected. They're a little more resilient against this virus.

              We needed to prevent those people who are getting hospitalized, who are getting very, very sick, who are going into the intensive care unit, and those were in the adult population, specifically those in the higher age groups. So, that's why we really focus this vaccine on adults.

              It's actually a lot easier to put together a vaccine for adults and a medication for adults than it is in children. If we tried to work on a childhood vaccine from the get-go, it would have been a lot slower, and the reason is is that there are a lot more protections when it comes to developing medications and vaccines for children.

              The difference is also that children, it is not a one size fits all. In adults, we think, "Well, almost every adult is about the same." There's a little bit, the young adult versus the older adult, but for the most part, all adults are created equal.

              In children, not so much. There is a big difference between a six-month-old, and a six-year-old, and 16-year-old both developmentally, as well as immunologically. So, when we are trying to develop vaccines, we actually have to think of children in different buckets of age groups because their immune systems are still growing, just like they are. So, we need to make sure that they're safe in each bucket of age groups, as well as effective in each bucket of age groups.

              So, we started with the oldest of children, the 16 and aboves, and we said, "Yeah. They're very much immunologically mature just like some of the 20 somethings and 30 somethings." So, therefore, they were actually segued in fairly early on. So, now, people who are 16 years of age and older can get the vaccine and have been able to do so for the last month or so.

              The next group is going to be that 12 to 15. After that will probably be somewhere between eight to 12 or six to 12, and then those patients, the youngest will be the last, and that will probably be the six-month to the five years, and those individuals will be probably the last to come. Probably you won't see a vaccine that is going to be ready for them until probably I'd say 2022. Maybe if we're really lucky, December of this year.

              Again, why? Because they are a population that we will watch extremely closely. There are a lot more variables, and let's be honest, there's a lot less of them than there are adults. So, we are not going to side step safety or effectiveness of research when it comes to children. We're going to make sure that we do everything right the right way, and we may do it quickly, but we're going to do it slowly enough so that we understand what is safe and what is effective.

              Unfortunately, that means that they're probably going to have to wait another year-ish or so, but, thankfully, because they're more resilient, they do have the ability to wait that time. If we wanted to help our kids, if we want to help the children in our schools and in our community, we ourselves get vaccinated, all right? If all the adults get vaccinated and we will then also basically be a ring of protection around the children.

              So, by vaccinating yourself, you are also helping your child or your neighbor's child or your kid's friend from becoming infected by this virus because they won't have the opportunity to get vaccinated whether they want to or not until for many, many months. I would expect that by next week we're probably going to be able to say yes. The 12 to 15-year-olds or at least the FDA is going to recommend that the 12 to 15-year-olds are going to be okay with the Pfizer vaccine.

Cassandra Holloway:

So, then with the potential drug that Pfizer is also working on to treat COVID-19, I don't know if you could speak a little bit to that course of treatment or just generally. I feel like treatment has changed drastically over the past year. Can you talk just about the general changes in treatment that we've seen?

Dr. Frank Esper:

Yeah. Listen. There's a lot of different medicines that have been tried or and are continued to be developed for this particular virus. The Pfizer one, I believe, is a protease inhibitor. This is a similar type of medication that we use for other viruses like hepatitis or HIV, and have been very effective in lowering the amount of virus that causes infection from those diseases.

              So, basically, we're taking what works for other viruses and seeing what can work against this coronavirus. There's a lot of different medicines that we have developed over the last year, again, the big one being the vaccine. The only medicine that's used right now for treatment of coronavirus is remdesivir. That's the only antiviral medication that we're using. We're also seeing that we're working with antibodies. Certain types of antibody treatments have also been FDA-approved to help prevent hospitalization or to help with people who are very, very sick.

              In addition to that, we're also seeing medicines that we've used for decades have actually helped the use and help treat patients who are sick with this virus. So, we've been able to repurpose medicines because we understand how this virus works now. We understand what this virus is doing and we're saying, "Hey, it's not the virus as much as it's the inflammation," and we're starting to hit it with specific types of anti-inflammatory medicines like steroids, which, like I said, we've used for decades, and tocilizumab, which is a much more newer medicine, but it's very specific against what this virus is trying to do. Why? Because we've learned how this virus works and we said, "Hey, I've got a medicine that stops that process. Let's work with it."

              So, there are a lot of medicines that we are creating a new, as well as old ones that we're saying, "Hey, this might help," and because of that, we do have a lot more treatment options that we did not have a year ago. Again, one of the reasons why this virus is not causing as much death, one is probably because the virus changes and, two, because we've gotten a lot better at treatment and, three, because we have a lot more treatment options in how to prevent this severe infection.

Cassandra Holloway:

So, the last thing I want to ask you about today is just your general take on what you think the future holds for COVID-19. Do you think the pandemic will every officially be over? I know we danced around this topic several times throughout this discussion.

Dr. Frank Esper:

Yeah. I think the pandemic will be over, all right? Nothing in life is ever forever, debt and taxes, but not coronavirus. It's not a part of that. So, the answer is that this coronavirus, while I don't think we are out of the woods yet, I still think we have a decent amount of time that we're going to be dealing with this coronavirus. Remember, just because the numbers in the United States are down, and let's be honest, we're not down. We still have levels as high as we did last summer right now. So, we're not out of the woods, but we can see what's going on in India, and we can see those things. It's only going to be a short amount of time where you could see spillover happen.

              So, until the whole world gets their vaccines out and gets their immunity up, there's going to be a pandemic, but within our local community, if we continue to do our job and we talk to our physicians and our nurses and our health providers and listen to the guidance from our state and local authorities, we're going to keep our numbers down to the point where we'll probably get to basically these winter peaks that is what we expect.

              I will say that once we get the whole world to a point where we're just seeing a few months of this coronavirus, that's probably where we're going to be for the remainder of our days is that this coronavirus will become like all the other viruses, and basically learn to live with us and we will learn to live with it, but we will continue to research it. We will continue to work with therapies so that we make sure that people don't die or get hospitalized, and that's going to be always something that's on our mind. This is a bad virus. Just like we spend billions of dollars to prevent flu, we're going to be spending billions of dollars to prevent coronavirus, all right? It's on par, maybe even a little worse than the flu once it gets to its little episodic changes. I don't know how the future holds, but I would definitely say that this is going to be one that we are going to be watching for at least the rest of my lifetime to ensure that it never causes a severe pandemic like it does again.

              Now, the one thing I will also say, and this is where I become the glass half empty doctor, is that this is the third coronavirus, the global outbreak of coronavirus that we've had in the last 20 years. We had SARS1 back in 2003. We have MERS, which is still brewing out there since 2011, and now in 2019, we have the COVID-19. So, we're averaging about a new coronavirus global outbreak every eight years. As the world has become smaller, people are being able to travel much more freely, this interconnectivity comes with global outbreaks. Remember, we were dealing with Ebola. We were dealing with Zika. These weren't even coronavirus, but we're seeing more and more of these infections that are able to spread far and wide very quickly.

              This is something that what we learned now and how we deal with it now is also going to work in our favor should another coronavirus show up in 2025, 2027, whatever it's going to be or another virus, a respiratory virus that's going to try to do something similar. So, what we do now is also both scientifically, politically, as well as you, yourself, within your household is going to pay off dividends when and if the next pandemic shows up, and it's probably more of a when than an if.

Cassandra Holloway:

Dr. Esper, thank you. You've been great to talk to today. Thank you for being here and sharing your insight with us.

Dr. Frank Esper:

Yeah. Happy to be here. Anytime, Cassandra.

Cassandra Holloway:

To learn more about coronavirus vaccines and to find additional information, visit clevelandclinic.org/covid19.

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